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[Bilateral hip joint replacement as a one-stage or two-stage procedure for dysplastic coxarthritis: a comparative
A Schiessel1, M Brenner, K Zweymüller
1Orthopädisches Krankenhaus Gersthof Wien, 2. Abteilung, Wielemansgasse, Wien. schiessel@aon.at
Insights
Single-stage bilateral hip replacement surgery is preferred by patients with hip dysplasia due to a single recovery process. This approach offers comparable outcomes to staged procedures with no increased complication rates.
Area of Science:
- Orthopedic Surgery
- Hip Reconstruction
- Biomedical Engineering
Background:
- Dysplastic coxarthritis often affects young, active individuals, necessitating hip joint replacement.
- Bilateral hip dysplasia can lead to significant impairment, with patients often desiring simultaneous correction.
- Previous surgical approaches for bilateral hip dysplasia involved staged procedures, increasing patient burden.
Purpose of the Study:
- To compare the outcomes of single-stage versus two-stage bilateral total hip replacement in patients with hip dysplasia.
- To evaluate patient preference and satisfaction between single-stage and staged surgical approaches.
- To assess complication rates and clinical outcomes, including quality of life improvements.
Main Methods:
- Retrospective study comparing 15 patients undergoing one-stage bilateral total hip replacement (Group A) with 15 patients undergoing two-stage bilateral replacement (Group B).
- Hip dysplasia classification followed Hartofilakidis and Crowe criteria.
- Outcomes measured included hemoglobin drop, blood transfusion requirements, Harris Hip Score, UCLA Score, and complication rates.
Main Results:
- The single-stage group (A) showed a higher mean hemoglobin drop (33.9%) compared to the first side of the two-stage group (B1: 25.1%) and second side (B2: 26.3%).
- Group A required more autologous blood transfusions (1.7 units) than Group B1 (1.1 units) and B2 (1.3 units).
- Both groups demonstrated significant improvements in quality of life, as indicated by Harris Hip Score and UCLA Score, with no increased complications in the single-stage group.
Conclusions:
- Patients with bilateral hip dysplasia preferred the single-stage total hip replacement procedure.
- The preference for single-stage surgery stems from undergoing operation, mobilization, and rehabilitation only once.
- Single-stage bilateral total hip replacement is a viable and preferred option, offering comparable results to staged procedures without increased risk.
Aim:
Dysplastic coxarthritis usually occurs earlier than primary coxarthritis. As a rule dysplastic coxarthritis mostly affects young and active individuals. Bilateral coxarthritis may lead to severe impairment requiring surgical replacement of both hip joints, as the patients are frequently dissatisfied with the substitution of one joint alone.
Method:
In a retrospective study, 15 patients with bilateral hip dysplasia who had received total endoprostheses in both hip joints in a one-stage procedure (group A) were compared to 15 patients with bilateral dysplasia who had been operated on bilaterally in two stages (group B). Group B was subdivided into B1 (first side) and B2 (second side). All dysplasias were classified according to Hartofilakidis and Crowe.
Results:
On the first postoperative day, group A experienced a mean drop of 33.9% in haemoglobin values, group B1 a mean drop of 25.1% and group B2 a mean drop of 26.3%. Patients of groups A/B1/B2 received on average 1.7/1.1/1.3 units of autologous blood and 1.2/0.1/0.3 units of foreign blood, respectively. Both groups experienced an improvement in their quality of life due to marked improvements in their Harris Hip Score and UCLA Score. Group A had no higher rate of complications.
Conclusion:
Although the single-stage procedure involved greater effort in terms of physiotherapy, patients preferred bilateral implantation of total hip endoprosthesis in a single surgical session because they needed to undergo the process of operation, mobilisation and rehabilitation only once.
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